Nur-634 Midterm 2023
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1. For which of the following patients would a comprehensive health history be
appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respira-
tory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand": ANS: C
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health history is
appropriate.
2. The following information is recorded in the health history: "The patient
completed 8th grade. He currently lives with his wife and two children. He
works on old cars on the weekend. He works in a glass factory during the week."
Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems: ANS: C
Feedback: Personal and social history information includes educational level, family of origin, current household status,
personal interests, employment, religious beliefs, military history, and lifestyle (including diet and exercise habits; use
of alcohol, tobacco, and/or drugs; and sexual preferences and history). All of this information is documented in this
example
3. Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lu-
pus erythematosus). She has noticed a raised, dark red rash on her legs. When
you press on the rash, it doesn't blanch. What would you tell her regarding her
rash?
A. It is likely to be related to her lupus.
B. It is likely to be related to an exposure to a chemical.
C. It is likely to be related to an allergic reaction.
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D. It should not cause any problems.: ANS: A
Feedback: A "palpable purpura" is usually associated with a vasculitis. This is an inflammatory condition of the blood
vessels often associated with systemic rheumatic disease. It can cut off circulation to any portion of the body and can
mimic many other diseases in this manner. While allergic and chemical exposures may be a possible cause of the rash,
this patient's SLE should make you consider vasculitis
4. Two weeks ago, Mary started a job which requires carrying 40-pound buckets.
She presents with elbow pain worse on the right. On examination, it hurts her
elbows to dorsiflex her hands against resistance when her palms face the floor.
What condition does she have?
A. Medial epicondylitis (golfer's elbow)
B. Olecranon bursitis
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture: ANS: C
Feedback: Mary's injury probably occurred by lifting heavy buckets with her palms down (toward the bucket). This
caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar
flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis
produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury
and would present more acutely.
5. Mrs. T. comes for her regular visit to the clinic. She is on your schedule
because her regular provider is on vacation, and she wanted to be seen. You
have heard about her many times from your colleague and are aware that she is
a very talkative person. Which of the following is a helpful technique to improve
the quality of the interview for both the provider and the patient?
A. Allow the patient to speak uninterrupted for the duration of the appoint-
ment.
B. Briefly summarize what you heard from the patient in the first 5 minutes and
then try to have her focus on one aspect of what she told you.
C. Set the time limit at the beginning of the interview and stick with it, no matter
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what occurs in the course of the interview.
D. Allow your impatience to show so that the patient picks up on your nonverbal
cue that the appointment needs to end.: ANS: B
Feedback: You can also say, "I want to make sure I take good care of this problem because it is very important. We may
need to talk about the others at the next appointment. Is that okay with you?" This is a technique that can help you
to change the subject but, at the same time, validate the patient's concerns; it also can provide more structure to the
interview
6. You feel a small mass that you think is a lymph node. It is mobile in both the
up-and-down and side-to-side directions. Which of the following is most likely?
A. Cancer
B. Lymph node
C. Deep scar
D. Muscle: ANS: B
Feedback: A useful maneuver for discerning lymph nodes from other masses in the neck is to check for their mobility in
all directions. Many other masses are mobile in only two directions. Cancerous masses may also be "fixed," or immobile
7. A 77-year-old retired bus driver comes to your clinic for a physical examina-
tion at his wife's request. He has recently been losing weight and has felt very
fatigued. He has had no chest pain, shortness of breath, nausea, vomiting, or
fever. His past medical history includes colon cancer, for which he had surgery,
and arthritis. He has been married for over 40 years. He denies any tobacco or
drug use and has not drunk alcohol in over 40 years. His parents both died of
cancer in their 60s. On examination his vital signs are normal. His head, cardiac,
and pulmonary examinations are unremarkable. On abdominal examination
you hear normal bowel sounds, but when you palpate his liver it is abnormal.
His rectal examination is positive for occult blood. What further abnormality of
the liver was likely found on examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
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C. Smooth, large, tender liver
D. Irregular, small, nontender: ANS: B
Feedback: With his past history of colon cancer and with recent weight loss and fatigue, a relapse of his colon cancer
would be expected. Colon cancer usually metastasizes to the liver, creating hard, irregular nodules, which can sometimes
be palpated on examination. A smooth, large liver which is tender is often seen in hepatitis.
8. A 21-year-old college senior presents to your clinic, complaining of shortness
of breath and a nonproductive nocturnal cough. She states she used to feel this
way only with extreme exercise, but lately she has felt this way continuously.
She denies any other upper respiratory symptoms, chest pain, gastrointestinal
symptoms, or urinary tract symptoms. Her past medical history is significant
only for seasonal allergies, for which she takes a nasal steroid spray but is
otherwise on no other medications. She has had no surgeries. Her mother
has allergies and eczema and her father has high blood pressure. She is an
only child. She denies smoking and illegal drug use but drinks three to four
alcoholic beverages per weekend. She is a junior in finance at a local university
and she has recently started a job as a bartender in town. On examination
she is in no acute distress and her temperature is 98.6. Her blood pressure is
120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose,
and throat examinations are essentially normal. Inspection of her anterior and
posterior chest shows no abnormalities. On auscultation of her chest, there is
decreased air movement and a high-pitched whistling on expiration in all lobes.
Percussion reveals resonant lungs. Which disorder of the thorax or lung does
this best describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia: ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated with a history of allergies and
can be made worse by exercise or irritants such as smoke in a bar. On auscultation there can be normal to decreased
Study online at https://quizlet.com/_dgcb6e
1. For which of the following patients would a comprehensive health history be
appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respira-
tory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand": ANS: C
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health history is
appropriate.
2. The following information is recorded in the health history: "The patient
completed 8th grade. He currently lives with his wife and two children. He
works on old cars on the weekend. He works in a glass factory during the week."
Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems: ANS: C
Feedback: Personal and social history information includes educational level, family of origin, current household status,
personal interests, employment, religious beliefs, military history, and lifestyle (including diet and exercise habits; use
of alcohol, tobacco, and/or drugs; and sexual preferences and history). All of this information is documented in this
example
3. Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lu-
pus erythematosus). She has noticed a raised, dark red rash on her legs. When
you press on the rash, it doesn't blanch. What would you tell her regarding her
rash?
A. It is likely to be related to her lupus.
B. It is likely to be related to an exposure to a chemical.
C. It is likely to be related to an allergic reaction.
, Nur-634 Midterm 2023
Study online at https://quizlet.com/_dgcb6e
D. It should not cause any problems.: ANS: A
Feedback: A "palpable purpura" is usually associated with a vasculitis. This is an inflammatory condition of the blood
vessels often associated with systemic rheumatic disease. It can cut off circulation to any portion of the body and can
mimic many other diseases in this manner. While allergic and chemical exposures may be a possible cause of the rash,
this patient's SLE should make you consider vasculitis
4. Two weeks ago, Mary started a job which requires carrying 40-pound buckets.
She presents with elbow pain worse on the right. On examination, it hurts her
elbows to dorsiflex her hands against resistance when her palms face the floor.
What condition does she have?
A. Medial epicondylitis (golfer's elbow)
B. Olecranon bursitis
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture: ANS: C
Feedback: Mary's injury probably occurred by lifting heavy buckets with her palms down (toward the bucket). This
caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar
flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis
produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury
and would present more acutely.
5. Mrs. T. comes for her regular visit to the clinic. She is on your schedule
because her regular provider is on vacation, and she wanted to be seen. You
have heard about her many times from your colleague and are aware that she is
a very talkative person. Which of the following is a helpful technique to improve
the quality of the interview for both the provider and the patient?
A. Allow the patient to speak uninterrupted for the duration of the appoint-
ment.
B. Briefly summarize what you heard from the patient in the first 5 minutes and
then try to have her focus on one aspect of what she told you.
C. Set the time limit at the beginning of the interview and stick with it, no matter
, Nur-634 Midterm 2023
Study online at https://quizlet.com/_dgcb6e
what occurs in the course of the interview.
D. Allow your impatience to show so that the patient picks up on your nonverbal
cue that the appointment needs to end.: ANS: B
Feedback: You can also say, "I want to make sure I take good care of this problem because it is very important. We may
need to talk about the others at the next appointment. Is that okay with you?" This is a technique that can help you
to change the subject but, at the same time, validate the patient's concerns; it also can provide more structure to the
interview
6. You feel a small mass that you think is a lymph node. It is mobile in both the
up-and-down and side-to-side directions. Which of the following is most likely?
A. Cancer
B. Lymph node
C. Deep scar
D. Muscle: ANS: B
Feedback: A useful maneuver for discerning lymph nodes from other masses in the neck is to check for their mobility in
all directions. Many other masses are mobile in only two directions. Cancerous masses may also be "fixed," or immobile
7. A 77-year-old retired bus driver comes to your clinic for a physical examina-
tion at his wife's request. He has recently been losing weight and has felt very
fatigued. He has had no chest pain, shortness of breath, nausea, vomiting, or
fever. His past medical history includes colon cancer, for which he had surgery,
and arthritis. He has been married for over 40 years. He denies any tobacco or
drug use and has not drunk alcohol in over 40 years. His parents both died of
cancer in their 60s. On examination his vital signs are normal. His head, cardiac,
and pulmonary examinations are unremarkable. On abdominal examination
you hear normal bowel sounds, but when you palpate his liver it is abnormal.
His rectal examination is positive for occult blood. What further abnormality of
the liver was likely found on examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
, Nur-634 Midterm 2023
Study online at https://quizlet.com/_dgcb6e
C. Smooth, large, tender liver
D. Irregular, small, nontender: ANS: B
Feedback: With his past history of colon cancer and with recent weight loss and fatigue, a relapse of his colon cancer
would be expected. Colon cancer usually metastasizes to the liver, creating hard, irregular nodules, which can sometimes
be palpated on examination. A smooth, large liver which is tender is often seen in hepatitis.
8. A 21-year-old college senior presents to your clinic, complaining of shortness
of breath and a nonproductive nocturnal cough. She states she used to feel this
way only with extreme exercise, but lately she has felt this way continuously.
She denies any other upper respiratory symptoms, chest pain, gastrointestinal
symptoms, or urinary tract symptoms. Her past medical history is significant
only for seasonal allergies, for which she takes a nasal steroid spray but is
otherwise on no other medications. She has had no surgeries. Her mother
has allergies and eczema and her father has high blood pressure. She is an
only child. She denies smoking and illegal drug use but drinks three to four
alcoholic beverages per weekend. She is a junior in finance at a local university
and she has recently started a job as a bartender in town. On examination
she is in no acute distress and her temperature is 98.6. Her blood pressure is
120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose,
and throat examinations are essentially normal. Inspection of her anterior and
posterior chest shows no abnormalities. On auscultation of her chest, there is
decreased air movement and a high-pitched whistling on expiration in all lobes.
Percussion reveals resonant lungs. Which disorder of the thorax or lung does
this best describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia: ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated with a history of allergies and
can be made worse by exercise or irritants such as smoke in a bar. On auscultation there can be normal to decreased
